This marks the fifth year that I've been writing this year-end series for T Nation. In my first installment, I was fresh out of graduate school, so I drew heavily from the research I'd seen.
Nowadays, while I still read a lot of research, more of my "findings" have come from being in the trenches (where I've also acquired a receding hairline). Hopefully this year, you'll find a nice blend of the two.
1. The "generalist" is a dying breed.
In the strength and conditioning industry, I increasingly see professionals spending time in specific niche markets almost exclusively. I'm a perfect example: about 80-85% of our clients are baseball players, despite that I never dreamed it would get to that point. (For the record, I'm not complaining; I love it.)
On one hand, specialization is a good thing, as it's a sign that if someone wants a professional who's uniquely prepared to meet their needs as a coach/consultant – and they're prepared to search for him/her – they can acquire these specialized services.
On the other, more negative hand, this era of specialization among professionals was in many ways born out of the fact that young athletes specializing in one sport at such young ages has led to a dramatic increase in movement dysfunction and injuries. Femoroacetabular impingement, sports hernias, spondylolysis, oblique strains, and Tommy John surgeries just weren't commonplace 10-15 years ago.
In other words, we've created a generation of aberrant movement patterns while concurrently increasing obesity in the population. In the process, we've created new industries. What are the lessons to be learned?
If you're an up-and-comer in the field of health and human performance, pick out something you really enjoy and become wildly proficient at it. Professional baseball players hate training with "football guys," and overweight diabetics aren't going to feel right training alongside NFL combine prep guys. You should still prepare generally, but definitely make a point of finding a specific area of expertise.
If you're a consumer, figure out exactly what you want, and then seek it out. Chances are that it's out there and easily accessible – especially if you're willing to travel.
2. The subclavius is a commonly overlooked trigger point in the upper extremity.
The subclavius muscle was the bastard child of anatomy instructors – it never got any attention. In fact, in spite of its self-explanatory name (below the clavicle), many in the health and human performance industries wouldn't even be able to tell you where it's located, let alone what it does.
Luckily, I can – and it was a huge game-changer for preventing and managing shoulder issues in our athletes.
The subclavius runs from the first rib up to the clavicle (collarbone), and when it shortens, it elevates the first rib and pulls the clavicle down.
Chronic repositioning of a rib or clavicle, even a little bit, is a big deal as it can affect several of the joints of the shoulder girdle very quickly and profoundly. It's not a muscle you're going to be able to easily stretch, but soft tissue work can be very helpful, so I'd encourage you to seek out a qualified manual therapist.
While having good manual therapy is always best, if you don't have access to it, you can get in there with a ball by running along the bottom of the clavicle toward the sternum.
Why does it happen? Above all else, it's due to aberrant breathing patterns. Many people struggle to use their diaphragm sufficiently for breathing, so they end up overusing supplemental respiratory muscles like the pec minor, sternocleidomastoid, scalenes, and, you guessed it, the subclavius. So along with the soft tissue approaches outlined above, try to be cognizant of not shrugging the shoulders up too much when breathing.
As an interesting aside, this relates closely to what I discussed in point #3 of my What I Learned in 2010 article. You'll find that the right subclavius is usually much more "balled up."
3. The anterior pubis is a commonly overlooked soft tissue region in the lower extremity.
While we're on the topic of soft tissue work, here's a commonly overlooked one in the lower extremity: the rectus abdominus – adductor longus aponeurosis. Let me explain.
I've talked about zones of convergence in the past. Basically, these are regions where the forces generated from a myofascial unit come together. One such example is on the anterior aspect of your pubis, where your adductor tendons all converge.
Your adductor longus is the most "vertical" of the bunch, and is the most commonly strained groin muscle. It attaches to the anterior aspect of the pubis via an aponeurosis that happens to be shared by the rectus abdominus.
The rectus abdominus pulls the pelvis posteriorly and superiorly, while the adductor longus pulls it anteriorly and inferiorly; in other words, they're direct antagonists. One (RA) yanks the pubis back and up, and the other (AL) takes it forward and down.
Many have considerable adductor restrictions requiring them to keep this "pelvis battle" even (the consequence of leaving it unchecked would be a groin strain and/or sports hernia).
It is, however, really hard to get in where those tendons insert with a foam roller. And it's not exactly a pleasant spot to have a manual therapist hit (even if that is the absolute best option).
So, what to do? Grab a ball, pin it between these tendons and the floor, and make sweet love to it.
The trick is to follow the adductor tendons up to the point at which they stop. Watch out for your junk, and please don't curse my name while doing this. That's creepy.
4. More than ever, you need to be an advocate for your health.
From 2007 (when we founded our business) to today, our per-employee health insurance costs have gone up 72% – even though our insured staff has doubled in size, which actually attenuated this increase. I see no signs of this letting up anytime soon.
I'm no economist, but when the price increases dramatically for a service that hasn't changed much at all, the bubble has to burst at some point.
If you ask any physical therapist, they'll tell you that insurance usually doesn't cover nearly enough visits with a given patient to address a problem the way they'd prefer. I foresee insurance companies cutting back even more on the quantity of services provided when they can't go any higher with prices, as they need to maintain their profit margins.
While I've no interest in turning this into a political debate on the direction our government will go regarding health insurance, there are two observations I'd make in this regard:
• Fewer afforded visits allowed by insurance companies favors the best physical therapists in distinguishing themselves, as they'll be the ones who get the quickest results. It may actually be a good thing in the context of increasing the number of PTs who use manual therapy, as it's a quick way to bring symptoms "under threshold" in many patients.
• Don't take your chances. More than ever, you need to take care of yourself and not get injured in the first place. No matter how boring it may seem, you need to do your foam rolling and mobility work, take deload weeks, and listen to your body when it's banged up. An ounce of prevention goes a long way.
5. We've overreacted to flexion.
For years, people didn't do anything to train the core. Then, thanks to an increasingly sedentary population and increased levels of athletic participation (and the desire to have a six-pack), people starting to work the core with specific exercises.
Initially, fitness and rehabilitation "specialists" encouraged these otherwise sedentary folks to do thousands of crunches and sit-ups – and we wound up with a generation with flexion-based back pain.
In fact, if you look at a New England Journal of Medicine study from 1994, even 83% of asymptomatic people have intervertebral disc bulges or herniations at one or more levels. Even the pain-free people qualify as "injured"!
So we yelled at everyone to sit up straight, and banished any sort of flexion from our training programs. The result? More extension-based back pain than ever, a greater incidence of stress fractures in young athletes, overuse of accessory respiratory muscles (diaphragm can't function optimally with the "ribs up" position you get with extension), and an athletic population that lives in anterior pelvic tilt. As you see to the left, this can actually make lean guys look fat!
People overcorrected to the point that they were living in extension, something you see with lifters and athletes involved in extension. Unfortunately, this extension bias hasn't been reflected in the way we program or cue exercises.
So, let me make this abundantly clear:
Flexion to neutral spine is entirely different from flexion from neutral spine.
The problem, however, is that we don't want to do a ton of crunches (which can pull the rib cage down and create a more hunchbacked posture), or sit-ups (which predominantly train the hip flexors and put a great amount of shear stress on the spine).
For that reason, I tend to start with the reverse crunch, which can posteriorly tilt the pelvis by way of the external obliques' attachment points without making someone more kyphotic.
Beyond that, spend some time regressing things. Work on prone bridges and stability ball rollouts to build up anterior core stability, but focus on not doing these movements in extension. Create a neutral spine before you initiate the movement, and then maintain it.
Above all else, you need to stop "hanging out in extension" all day. Brace the core and activate the glutes throughout the day until you're subconsciously holding a more neutral spine position.
6. Hip mobility "sticks" far better when you train core stability at greater hip ranges of motion.
Since this one relates closely to #5, I thought I'd follow up with it right away.
Everyone has stiffness (and sometimes truly short tissues, too) at the hips. Basically, when the soft tissue structures at the hips are stiffer than the muscles acting at the lumbar spine, we wind up moving in the path of least resistance, creating lumbar instability and allowing "energy leaks" to take place that decrease performance.
Physical therapist Shirley Sahrmann championed the approach of creating stiffness at adjacent joints (lumbar spine) to the stiffness (hips) to improve clinical outcomes in the rehabilitation community years ago. More recently, Gray Cook and Mike Boyle introduced these thoughts on a whole-body scale to the performance training world in a solid framework with the joint-by-joint approach.
Get soft tissue work at the hips, and you'll transiently reduce stiffness.
Do thorough warm-ups for the hips or simply do some static stretches, and you'll transiently reduce stiffness.
Build core stability, however, and you'll make these changes stick.
One avenue through which we've had great success with making these improvements quicker and more long-lasting is to simply introduce core stabilization exercises with greater hip range of motion.
Short adductors? Train rotary stability with a wider stance after you've done some adductor soft tissue work and dynamic flexibility drills.